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Assessor's map,and lot `number ....:...... /. .'-••/...�? SEPTIC SYSTEM MUST 13E �,5 ter'
INSTALLED IN COMPLIANCE
cJ ti °�� ' �- ,' WITH ARTICLE II 'STATE
Sewage Rermi ;numer �Q�..... n
SA;1ITA??Y CODE AND TOWN
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BARX3TSDLE,'
" as R;UIt,D:I-NIG INSPECTOR
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Cu ..y cj f•r ay V .`�_
L APPLICATION('FOR tPERMIT TO . ..�� � ...... .�................t, ..........................................
;:.. TYpE OF CONSTRUCTION ......: . �..,....... .�. ....,. ...............................................................
...... . , .......c.............................19?
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TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location ....... �3 . ................... 1................................................................
ProposedUse .........................................................................................................I.........................
ZoningDistrict ................................................ .......................Fire District ........... ........... ...............
Nameof Owner ... t� /y,�.e-......... '' Gi''o�?�cAddress ................... ...... .........................................................
Nameof Builder � ' Address ........................................:............ .,f!............................ ......... ... ..��
Name of Architect...../e.l .. ..-'...............:..............Address ..... .. .....................................
Number of Rooms ..................Foundat on '
/.............................. /... ....�lJ.......... Ull 'F' :............. .............
Exieriorj/(....... ......... v�?.!�71.`�3.e. :.......Roofing ....����3-......... .........................................
Floors ............... .............................
........................ ...
Heating ......... r ........................Plumbing ...... ......
Fireplace .......... ............ . ..........Approximate Cost ..... wd..........................................
Definitive Plan Approved by Planning Board ________________________________19________. Area ..... ........ ..............
Diagram .of Lot and Building with Dimensions. Fee � / '....................................
SUBJECT TO APPROVAL OF BOARD OF HEALTH
6
♦ //�/(7�� -n1/
I hereby agree to conform to all the Ru el s and Regulations of the Town of Barnstable regarding the above .
construction.
_ Name .. �;. .., �--:--
4
Tellegen Ferrone Assc. , I c.
PQ. two story
No.................. Permit. for ....................... ............ '
......sin1le I am
ly..dwelling .
l'CUl- ,
Location' ..... ...M� ... ....... . . '. -
i AL
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nt ry 11
OwneCTgLlegen Ferrone Associates,..Inc.
' Type of,Construction w od fr m
I ................................................................................
Plot ............................. Lot #13......................
Permit Granted ...Xar.ch..16...................19 77 ,
Date of Inspection .GV.2"..V...5.1 .......19 Y
t�
Date Completed .... ....... ...........19
PERMIT REFUSED ,
i. ......................................................t ....... 19
1 ..................................................... ,
r, ................................................... ....................
_ ":ter .
..............................................................................
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..........................y... ........................ .................
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✓Approved ................................................ 19
................................................ ...........................
..................... ......................................................... r
Assessor's map and lot number f
t Sewage Permit number ....... ............................................
f TOWN OF BARNSTABLE
ii
i B9SBSTODLE, i
"6 9 �•� RUIHING INSPECTOR
0,,�0 YpY a
r APPLICATION FOR PERMIT TO ......... . >.;/c ......................................... ...........................................
. TYPE OF CONSTRUCTION .......... ...! .,v a.......... - ................ ..............................................
............... ...........
19........
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location .. -'` �.................................
.... E............... ..........�.....
ProposedUse ........::.. ...................�..............................................................:............................................................................
Zoning District .........................................................................Fire District .......... '.c' x `��.......... .:::....................
Nameof Owner ......................./ ..................................................,�t. ..�f Address ...................................................................................
Nameof Builder ...................................................................Address ............ .. .........................................................
,- --
Name of Architect .......Address '.
�Number of Rooms ..................................................................Founda-tion ............................ ................................................
f / / v
Exierior � ............... Roofing .... ......... ;?...........................................
Floors /Ji✓r2....- ...��. `!'��-�.- 1,�'oc df
.....................Interior ............ .........................................................
r
(V,-�
Heating �� /.�s - g /f�� .o��'�: . i`2.
. .......................................Plumbin
Fireplace ......... -s�'r"'................ ? ....... ...........Approximate Cost ................Gc...`............................................
Definitive Plan Approved by Planning Board ________________________________19-------- . Area ....6......Z... �................
Diagram of Lot and Building with Dimensions Fee `SZ
SUBJECT TO APPROVAL OF BOARD OF HEALTH
fb0 '
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
Name .....,............. {-'......... f------_..
r
y Tellegen Ferrone Ass&., Inc.
192 - •168
4 "
r Nol.l•9021...... Permit for .V..0-4.0.ry................
I •
1 i
...-r.,i,ng.le-family.jw Idwelling...........................
Location .Lot...#13-f-aptain-L.ijah...Rd.........
.....Gen•ter•Sri-Ue..................................................
.....xe 1i ag�a..ILe1^1^..
f Owner .: .one,Associates; Inc.
r �
E .� •
{ Type of Construction . .vaoitiAraMe................
t
► Plot ............................ Lot ...#13.......................
a
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Permit Granted .......March...16...............19 77
t '
t Date of Inspection
Date Completed 19
PERMIT REFUSED
t .......... ..... ......... 19
. ..... .1. !.17i .......... ... .................................
} ............................... ................................................
........... . ............
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Approved ................................................ 19 ;
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i .. ............... .........................................................
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Assessor's map� and lot nUmber.AKA�
t639-
TOWN OF BARNSTABLE -
' �� NN N N �� 0 ���� N �� �� ��
` . �� NNNN-00N ��0� N ��������0m0NN ��
���» �
' APPLICATION FOR PERMIT TO --�9�������..y�����g�------..�~�x����.����.----..------.
'
TYPE OF CONSTRUCTION ...............Wo6.d..f�a�e.=--.-----------.--_-----_--..----
' 2 8�
� —..���\��.�------..--..l9.--'
TO THE INSPECTOR OF BUILDINGS:
The undersigned 6eva6y applies for o permit according to the following information: �
Location ......Lot...l3..Capt..._L.ijmb'.a...Bo.ud.,....Ceote__l.le...................................................... ......................................
S �ouo�
Proposed Use ---�����..������.. -------.^________________________.________
.
Zoning District —'DaoldeotiaI—~ �T �-^!_______..Finy District ..Ceot-Ost___________________.
'
Nome of Owner ...Jam.#m..D�_Smi.tb____________A66reu ___8srootable,_________________
Nome of Builder .Jameo...K..-8mi.t,h....................................Address ----------------------------
Nome of Architect ----------------------A66nss ----------------------------
Nvm6e, of Rooms --- �va..................................................Foundation ... !
..........................................
Goeho, z '&'9^c^��------------'Roo�»g --'i��P��.............................................................
' ��—. -----�
Floors ........bazdwomd.............................................................Interior ......... l............................................................
| Heating _.gq§.�����_air_____------------.Mum6ng --2.���tbg--.-------------.---
�6� 000
Fireplace —�4�--------r--------------'Approximate [os .---^.=�-----____._____.,_
Definitive Plan Approved by Planning Board --------------- l9--------. Area v^ �-��#................. '
Diagram of Lot and Building with Dimensions Fee __ yT________
�
SUBJECT TO APPROVAL OF BOARD Of HEALTH
� 28 x 50
14x24 garage
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�
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OCCUPANCY PERMITS *REQUIRED FOR NEW DWELLINGS
^ _ '
| hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
'-
\>Nome \\
. �L�... -
��...,r��}��.����.—.--.---.,
5I90 �
. Construction Supervisor's License ------------
�
SMITH, JAMES K. A-194-23
No ... ... Permit for .... stP.0.................
le
i�IQ9 Arn.i.).y...4Wp.1.1...Q g........................
LA\
Location A Rd.
..............
Centerville
..................................................................... ..........
Owner .........James..K.—Srui.th..........................
Type of Construction ..... rime..... ...................
................................................................................
Plot ............................ Lot .................................
Permit Grant4yq.b.s't...2...................:........9 84
Date of Inspection ........................... ......19
,Date Completed .......................................19
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Town of Barnstable *Permit 3
Expires 6 month from issue date
Services .... .Fee... r
.a�►ss. $ - •„�, - ,Thomas 7.•Geller,Director
X mP ES, E
Building CommissionerR005
.200 Main-Street,-Hyannis,MA 02601-:—
Office: 508-862-4038 _ .- , TOWN OF-BARNSTABLE.
Fax 508-79'0-6230' . ..'-. . ::::; :;.:.;:--.:.:_;: . r .: -RE5ID�NTTAL ONLY. -' '
.. -- ... . -••-�XP�S:S;SET.A�pLIC•A�'T,bN - - .
Not Valid withoutRed X--Press Imprint
Map/parcel Number
Property Address
Residential Value of Works Minimum fee of$25.00 for work under$6000.00
Owner's Name&Address
�.� Telephone Numbuffe ' �� �
Contractor s Nam
ellC®p
Home Improvement Contractor License#(if applicable) 6 �O y
'Q �
Construction Supervisor's License#(if applicable)
❑Workman's Compensation Insurance '
Check one:
❑ I am a sole proprietor F
-_ ❑ Lam the Homeowner
I have Worker's Compensation7nsurance 00
Insurance Company Name
Worl�s Comp.Policy#
Copy of Insurance Compliance Certificate'must be on fife.
Permit Request(check box)
❑ Re-roof(stripping old shingles) All construction debris will be taken to
Re-roof(not stripping. Going over existing layers of roof)
'(Re-side "
R lacement Windows U Value s Z (maximum.44)
�' - S l�� V4,111c V �-�Za .�l�G
ric Conservation,etc.
_ d i.e.Histo ,
� ov ons
att
artrnent re 1 ,
d
then town �
*Where required: Issuance of thus permit does not exempt compliance with o ep
***Note: Property Owner must sign Property Owner Letter of Permission.
License is
/ Home Improvemen
tractorsrequired.
1�
Signature
i Q:Farms:expmtrg ., ,
Revise063004 .. .
T.
TME Town of Barnstable
o� lo+yti '
o� Regulatory Services
Thomas F.Geiler,Director
Buil.cltng DIVISIOU
Tom Perry, Building Commissioner
200 Main Street, $yannis,MA 02601
www.town barnstable.ma.us
Fax; 508 790-6230
Office; 508-862-4038
Property owner Must
Complete and Sign This Section
If Using A,Builder
as owner of the subject property
I, p to act on mybehalf;
'hereby authorize
fitters relative to work authorized by* s building permit application for,
In
Zv
(Address of Job}
ignature of Owner
A/�
Print Name
. L t
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office atinuesdgadens
600 Washington Street, a Floor
Boston,Mass. 02111
Workers'Compensation Insurance Affidavit:Buildin /Plumbin /Electrical Contractors
name:
address:
city �✓�' �� state: ,/J�G 4 2:i : ?6 y hone#
work site location full address):
❑ I am a homeowner performing all work myself. Project Type: ❑New Construction Oemodel
❑ I am a sole ro rietor and have no one workin in an ca aci . BuildingAddition
MAMMOMM
I am an employe rov'dmg workers' compensation for my�employees working on this job
{ ? t Y y "r�'' Fri
COtil a�n ;•''itne.,._ `.. �, _5...
p
8�dfeSs.' A4 i ���.:. i. L•r,.. .,^.t ,�r`i `.'!��• ,k�,. .,s r a �`r_� .t �'s �
... {� W '�"ryf
]R5.11T971CC'e�' t..._u. < ..: >r,... :a ..... .�':....,V!......,..«.< LC,. ......,. -
if
❑'-I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have
the following workers' compensation polices
., ._. - ." x �#,.. .� .,. � ,xm., •!Ljxfx�.,#�A., '� ��°�` - :rr r^'"i, Y,. g, u. +
4
camoanvn'ame - -
r
'at;.dress. `1.. ,� '+. � _ ..::-t* 1.E.•uer+'' i. } - —
ity ntione#
< T
insuranee a"a „ ...__ olic.t}:...< ...
i:omaanvra'me t' t-
0
r r
city ylione#
' lr
iti5arance eb+_._:n Q c .#.:::
Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or
one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a
copy of this tatement may be forwarded to the Office of Investigations of the DIA for coverage verification.
I do hereby ce under the pains and ena 'es of perjury that the information provided above is true and coo rect.
Signatur Date Vj
Print name Phone#CJ��+
official use only do not write in this area to be completed by city or town official
city or town: permit/license# ❑Building Department
❑Licensing Board
❑check if immediate response is required ❑Selectmen's Office
[]Health Department
contact person: phone#; ❑Other
(revised Sept 2003)
f
Information and Instructions
Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their
employees. As quoted from the"law", an employee is defined as every person in the service of another under any
contract of hire,express or implied,oral or written. ' _ _ E .X.
An employer is defined as an individual,partnership,association,corporation or other legal entity,or any two or more of
the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer, or the receiver
or trustee of an individual,partnership,association or other legal entity,employing employees.'However the owner of a �.
dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of
another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds
or building appurtenant thereto shall not because of such employment be deemed to be an employer.
MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business*or to'construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required.
Additionally,neither the commonwealth nor any of its political subdivisions shall enter into any contract for the
performance of public work until acceptable evidence of compliance with the insurance requiiements of this chapter have
been presented to the contracting authority.,
Applicants
Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation. Please
supply company name, address and phone numbers along with a certificate of insurance as all affidavits may be
submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and
date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is
being requested, not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if
you are required to obtain a workers' compensation policy,please call the Department at the number listed below.
City or Towns
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of
the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please
be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned to
the Department by mail or FAX unless other arrangements have been made.
The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address,telephone-and fax number:.
The Commonwealth Of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street,71h Floor
Boston,Ma. 02111
fax#: (617)727-7749
phone#: (617) 727-4900 ext. 406
i
rt
6711
Board of Building Regulations and Standards
One Ashburton Place - Room 1301
Boston..Ma. usetts 02108
Home Improveetf actor Registration
Registration: 106024
Type: Trust
Expiration: 7/21/2004
DAVENPORT BUILDING COMP YT�r.JS
Dewitt Davenport - a
20 North Main Street _
South Yarmouth,_MA 02664
54
Update Address and return card.Mark reason for change.
n Address F� Renewal 1-1 Employment
_.... n Lost Card
Board of Building Regulations and Standards
License or registration valid for.individul use only
HOME IIVIPRO�VEMENT CONTRACTOR before the expiration date. If found return,to:
Re ►sCrat�.:on 1; 6024 Board of Building Regulations and Standards
x � ttto�7/:�j2004 One Ashburton Place Rm 1301
Boston,Ma.02108
I
DAVENPORT
RT BU I. l
be'r wi�t'Davenport €2.
20 North Main Street
South Yarmouth, MA 02664 -� �
Administrator 4Notali out signature '
j
t
':' ✓/GG�O��IJZO�ZUIGCGLCIG tC4(ALLGOeGLd., ' ,.. .
�i
BOARD OF BUILDING REGULATIONS ..
License CONSTRUCTION SUPERVISOR
Number S� 072866
Birth35-f�05f06/1951
Expires51
Wo
00 Tr.no: 10655
% �`i
Rest'i e� 1 c
DAVID A:'$AURA : 1 SS
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163 TERN LANE
CENTERVILLE; MA 0263_ 9 Administrator
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Y' OF, BAa,A"TABLE
Town of Barnstable'
FSHE tp� �3rr r-; 2
ti Regulatory Servi&4� IS
r I �,, :
y Thomas F.Geller,Director -
+ =ARNMEtF s
9 . . $ Budding Division_....._..,..—.•..,:_.
1 39• ter •,-------_.-
AIED MP'1 Tom Perry,Building Commissioner
ISION
200 Main Street, Hyannis,MA 02601
Office. 508-862-4038 �C Fax: 508-790-6230
PERMIT# FEE; $
SHED REGISTRATION
120 square feet or less
Village.
Location of shed(address) Vi ,
Property owner's name Telephone number
Size of Shed Map/Parcel#
i
Sign�turaa Date
Hyannis Main Street Waterfront Historic District?
Old King's Highway Historic District Commission jurisdiction?
Conservation Commission(signature required)
PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE
COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE.
PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS.
THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN
Q-&rms-shedreg
REV:121901
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NSF D£NNIg MEAGHECZ !
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LOT 13
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OCATION JF S fi
I LF '�id - ONCE0 G,JId.S OF pF
,.
- Y•A MORE ACCIJRA`-E LOCANTION
WIL IRE AN INSTRUMFN
t._ T
JOHN S LA I _URETA'N -` - -
Scale: {" 40'
PROFESSIONAL LAND SURVEYOR,
HEREBY CERTIFY THAT THE AMERIOAN SURVEYING COMPANY
30VE MORTGAGE INSPECTION 1264 Main-Slfeet,-Wallham;MA 02451 (781)893-6477'
N WAS PREPARED FOR � _'- - - -
,pp .,
3ADIUS FINANGIA �N
)NNECTION WITH A NEW MORTQAGE -
JD IS NOT REOR,PINTENDED OR-qEP 3
Mo:rtgage 1= spec Plan '
Pl
:NTED TO BE A LAND OROPggTY _
VE SURVEY. NO CORNERS RE THE LOCATION OF THE ORIGINAL RECORDED AT E
• IT l'AdtW BE USED FOES- DWELLING SHOWN HEREON EITHER BOOK 1 COUNTY REGISTRY OF DEEDS
tBLISHING FENCE, HEDGE OR WAS IN COMPLIANCE WITH THE LOCAL pLAN —PAGELO,,,`�L_7C Ce�r� , M.
IILDING UNES.TILE LANOAS SHOWN APPLICABLE ZONING BYLAWS IN EF. DRAWN PER ER TOWN OFP
:REON IS BASED ON CLIENT FUR- FECT WHEN CONSTRUCTED WITH RE-iMAP r PARCEL r ASSESSORS {
'SHED INFORMATION-AND MAY BE SPECT TO HORIZONTAL DIMENSIONAL ADDRESS: A t�q --DATED
IB H C E JECT O i'E 1 T .FURTHER OUT-SALES REQUIREMENTS L�
KINGS,EASEMENTS AND RIGHTS OF FROM VIOLATION OENFORCEMENTAC. 1::O1:1R3WER:�B1SCoLl 1
kY• MQ RESPONSIBILITY IS EX- TION UNDER MASS.G.L.TITLE VII,CHAP.
NDED HEREIN TO THE LAND OW14ER 40A, SEC. 7, UNLESS OTHERWISE SUBJECT DWELLING UES IN FLOOD ZONE
1 OCCUPANT,IT IS NOT INTENDED NOTED OR SHOWN HEREON.A CON- AS SHOWN ON NATIONAL FLOOD INSURANCE PROGRAM FLOOD
BE RECORDED. FIRMATORY INSTRUMENT SURVEY INSURANCE RATE MAP DATED 7—
ITE 9 24101 IS J10VISED WHEN STRUCTURES ARE COMMUNITY_PANEL r
TENT—O'CONN�R �• J$H�Wk TO'k V OR LESS FP,OM
LENT REF./ 014�i5 PROPERTY OR REOU!RED ZONING FIcLOED DRAFTED CHECKED
-r 9007n601 SETBACK LINES. BY BB p
DATE G
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